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NCLEX NCLEX-PN Question # 168 Topic 17 Discussion

NCLEX-PN Exam Topic 17 Question 168 Discussion:
Question #: 168
Topic #: 17

A client with Kawasaki disease has bilateral congestion of the conjunctivae, dry cracked lips, a strawberry tongue, and edema of the hands and feet followed by desquamation of fingers and toes. Which of the following nursing measures is most appropriate to meet the expected outcome of positive body image?


A.

administering immune globulin intravenously


B.

assessing the extremities for edema, redness and desquamation every 8 hours


C.

explaining progression of the disease to the client and his or her family


D.

assessing heart sounds and rhythm


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